Conflicting Swab/Blood Test Results

[Kfs5093]

Hi Terri!
I started experiencing vaginal discomfort the end of October. My symptoms included excess discharge, itchiness, redness, and skin separation near the outside fold of my vagina. My doctor described them as paper cuts but it looked like the skin just split.

Fast forward to 12/14, I was seen by an NP. She immediately diagnosed me with a yeast infection and BV. She ran a full STD panel with herpes. The swab came back 12/17 positive for GHSV2, positive for yeast, negative for BV. I was surprised by the diagnosis as I never presented with a “typical” herpes sore/blister but began my research. I asked my recent partners but they had never experienced any symptoms. I was put on 1g of Valtrex twice a day for 10 days. Once I finished that, I was put on 500mg of Valtrex once a day.

12/21 I saw my gyno to talk about the results. I requested an IgG and an IgM to see where my antibodies index came in at. So I tested the blood at 8 weeks post exposure and both blood tests came back negative (no index value given). The blood and swab tests were performed by Quest. My gyno recommended testing in 4-6 weeks to check the levels.

1. Does this sound like herpes?
2. Do you recommend having another IgG test in 4-6 weeks?
3. Any other steps you would recommend? My gyno recommended seeing an infectious disease specialist if the next IgG came back negative.

The blood results kind of threw me for a loop and I just want to get to the bottom of this. Thank you!

[Terri Warren]

1. Does this sound like herpes?

Generally speaking, we believe the swab test over the IgG test every time, especially since the swab test was taken from broken skin. Have you been taking antiviral medication on a regular basis? That could cause a false positive result on the IgG test is taken close enough to a primary infection

2. Do you recommend having another IgG test in 4-6 weeks?
The IgG test for HSV 2 misses 8% of HSV 2 infections so you could try it again but I don’t have confidence that it will help you sort this out.

3. Any other steps you would recommend? My gyno recommended seeing an infectious disease specialist if the next IgG came back negative.

I don’t think you need an ID doc – what would they do?
Let me know about your medication dosing if any. I would suggest the western blot for clarification if you don’t believe the swab test because of the negative IgG result.

Terri

[Kfs5093]

Hi Terri,

I was put on 1g Valtrex twice a day for 10 days beginning 12/17. The blood tests were taken 12/21 so the Valtrex could have affected the results. Starting on 12/26/20, I was put on 500mg of Valtrex once a day for daily antivirals.

I am questioning the swab results, just seems kind of out of the blue.

[Terri Warren]

Yes, your Valtrex dosing could most definitely be impacting your IgG results, no question. You can and probably should believe the swab test. But if you want a more definitive antibody test, you could stop antiviral medication for 12 weeks and re-test. If you do that, you should remember that you are more infectious to others OFF medication and take that into account.

Terri

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